NEW YORK (Reuters Health) - Preemptive use of lamivudine reduces overall hepatic morbidity and the severity of clinical hepatitis in patients with hepatocellular carcinoma (HCC) undergoing chemotherapy, Korean researchers report in the February issue of Hepatology.

Lead investigator Dr. Jeong Won Jang told Reuters Health that "chronic hepatitis B virus -- HBV -- carriers have a higher incidence of hepatic complications during cytotoxic therapy, most of which seem to be associated with HBV reactivation."

To evaluate the efficacy of preemptive lamivudine therapy in such circumstances, Dr. Jang and colleagues at the Catholic University of Korea, Seoul conducted a prospective, open-label study of 73 patients with HCC who were undergoing transarterial chemo-lipiodolization (TACL). Patients using epirubicin and cisplatin at monthly intervals were randomized to receive or not receive lamivudine (100 mg daily) from the start of TACL.

The researchers found that lamivudine significantly reduced overall hepatic morbidity. "In addition to the lower occurrence of viral reactivation, which was not unexpected," Dr. Jang noted, "lamivudine therapy used in this preemptive manner decreased the occurrence of overall hepatitis and the severity of any clinical hepatitis developed during chemotherapy."

The authors also observed that patients with HBV levels higher than 10,000 copies/mL were at greater risk of hepatitis due to viral reactivation.

"This population would benefit more from the preemptive therapy," Dr. Jang said, but warned that the conclusions are based upon a small number of patients. "The definitive cutoff level of viral loads that justify the preemptive use of antiviral agents," he concluded, "should be determined in future large studies."